Provider Demographics
NPI:1245576149
Name:BRENNER, RUSSELL (DC)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:
Last Name:BRENNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5100
Mailing Address - Country:US
Mailing Address - Phone:516-224-7579
Mailing Address - Fax:
Practice Address - Street 1:2468 N JERUSALEM RD STE 15
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1122
Practice Address - Country:US
Practice Address - Phone:516-208-6123
Practice Address - Fax:516-208-6122
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012276-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor